| NPI | 1124031315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401413330) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS035800) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2011-08-18 |